Multi-stakeholder Pledge: National Health System Inclusion
Multi-stakeholder Pledge: National Health System Inclusion
Key outcome
Foster sustainable and equitable access to health care and related services at affordable costs through strengthened national health systems for all refugees and host communities.
Pledge description
Achieving inclusion in national health systems: Support to national health systems to facilitate inclusion of all refugees, other forcibly displaced and stateless people through policy changes to advance on inclusion, supported by financial, material and capacity strengthening, to foster equitable access to quality health services for refugees and host communities.
Commitments related to this multi-stakeholder pledge may include:
- Law & policy. Changes in national legislative frameworks such as health laws and national health policies as well as the inclusion of refugees into national social health protection schemes, including into non-contributory systems. Pledges will focus on the different dimensions of health and health services, including preventive, promotive, curative, rehabilitative and palliative care, and may also link with inclusion of refugees with disabilities into national systems. Pledges will also include elements of health system preparedness and response to support States and non-state actors in preparing for future displacements, disease outbreaks and other public health risks.
- Programmes. Financial support for sustainable inclusion in health system and social health protection schemes; technical support to enable policy change; capacity building of personnel and volunteers; support to health service delivery in refugee hosting areas through infrastructure adjustments, human resources, medical products and technology; fostering work opportunities for accredited refugee health care providers; community engagement and mobilisation in health actions; expanding the use of mobile technologies for telemedicine. Linked measures to overcome barriers related to language and culture to access healthcare at local level and make services culturally relevant. Work in settings outside formal healthcare settings, such as leveraging school settings to deliver health services and strengthening referral pathways between service providers who provide child-critical services. Support measures to overcome barriers for accessing health services and systems, including for refugees with disabilities.
- Data & evidence. To support evidence-informed planning, programming, monitoring and inclusive law and policy making through the provision of tools, expertise, and data disaggregated by age and gender to advance measurement and build the evidence-base related to refugees’ inclusion in national health systems and improved health outcomes for refugees and the communities hosting them.
It is expected that new and existing policies will be pre-matched by donors, international financial institutions, international organisations, UN, NGOs, academia and private sector with financial, technical or material support.
Background
Addressing the health of refugees, other forcibly displaced and stateless people has never been so important. More people than ever are forcibly displaced, and global health challenges are increasing as witnessed by the COVID-19 pandemic. The situation is becoming more complex as conflicts persist and climate change impacts health and disease patterns. Good mental health is critical for every person to cope with the stresses of life, to realize their abilities, to learn well and work well, and to contribute to their communities.
Nevertheless, refugees, other forcibly displaced and stateless people often face inadequate access to and do not adequately benefit from culturally appropriate health services. Attending to their health and mental health needs is essential for their physical, social and mental well-being during all stages of life.
WHO and UNHCR jointly launched the Group of Friends of Health for Refugees and Host Communities in May 2023 comprised of States, refugees, private sector partners, NGOs, academia and international organisations to achieve sustainable inclusion into national health systems, to strengthen national health services and to systematically include mental health and psychosocial support (MHPSS) actions in the response to achieve lasting change for refugees and host communities alike.
The Group of Friends Health has dedicated workstreams to advance the inclusion of refugees in national health systems and mental health and psychosocial support.
Related pledges to match
GRF-00417 - Promover la cobertura de aseguramiento a flujos migratorios laborales ordenados del 100% de los casos de refugiados y so.
GRF-00456 - Government of Djibouti - Improve investments in healthcare services by strengthening health facilities at all levels (I, II and III) in refugee hosting areas. Find out more about matching this pledge.
GRF-00473 - Government of Egypt - Assistance/health, w universal coverage for all, adopting a National Law and bylaws stipulating access to health within existing coverage systems Find out more about matching this pledge.
GRF-00480 - Government of El Salvador - Improving health care services for internally displaced persons, deported persons in need of protection, refugees and asylum seekers Find out more about matching this pledge.
GRF-00571 - Government of Ghana - Every child enjoys free education up to senior high school. Primary health care and UHC for all, including refugees. Find out more about matching this pledge.
GRF-00501 - Government of Kenya - Inclusion of refugees in County Development Plans and area-based approaches to building resilience by mitigating the impact of protracted displacement on host communities and preparing refugees for solutions Find out more about matching this pledge.
GRF-00536 - Government of Lebanon - Reaffirmation of Commitments expressed by the Government of Lebanon at the Brussels Conferences on supporting the Future of Syria and the Region, and the joint monitoring framework for implementation Find out more about matching this pledge.
GRF-00616 - Government of Malawi - Inclusion in National Development Agenda Find out more about matching this pledge.
GRF-00664 - Government of Mauritania - Ensure the inclusion of refugees in health services under the same conditions as nationals Find out more about matching this pledge.
GRF-00702 - Government of Mozambique - pledges to continue the local integration practice, aiming at stronger synergies between refugees and host communities, and increase access to education, health and basic services for refugees and host communities by 2023. Find out more about matching this pledge.
GRF-00705 - Government of Namibia - The Government supports the Osire clinic that serves refugees, including deployment of medical staff, medical equipment, medicines, etc; the government also supports access to wrk permits by refugee medical professionals to serve in government and private hospitals.
GRF-00778 - Government of Nigeria - Nigeria pledges to ensure the availability and access to durable solutions for refugees and IDPs Find out more about matching this pledge.
GRF-00749 - Government of Sudan - Integrate health services for refugees in National Health System in a gradual manner Find out more about matching this pledge.
GRF-01017 - Government of Uganda - Promote access, quality, and inclusiveness of national health services for refugees and host communities Find out more about matching this pledge.
27 March 2024 - Post GRF follow-up
Key statistics
Since the affirmation of the GCR in 2018, individuals, private businesses, organisations and governments have made 96 pledges1 to advance the health inclusion and mental health of refugees and host communities and work towards universal health coverage. Working towards the GRF 2023, an additional 235 pledges were made by multistakeholder partners on health inclusion and mental health and psychosocial support. Of those, 153 pledges were submitted related to inclusion in national health systems, including 102 directly linked to the multistakeholder pledge. Altogether 125 entities from across the world pledged their support, aiming to reach more than 36 million people2. The largest number of the pledges were submitted by States, including 27 low- and middle-income refugee-hosting countries.
The multistakeholder pledge benefits from commitments made from across the world to foster sustainable inclusion in strengthened national health systems. The largest number of pledges were received from Europe and the Americas (35 each). Pledges target all regions, including global pledges with organisation-wide commitments to foster inclusion.
Region | Pledges from | Pledges to |
Americas | 35 | 24 |
Asia & the Pacific | 20 | 25 |
Eastern Horn of Africa & the Great Lakes (EHAGL) | 10 | 17 |
Europe | 35 | 15 |
Global4 | 19 | 37 |
Middle East & North Africa (MENA) | 13 | 13 |
Southern Africa | 8 | 8 |
West and Central Africa (WCA) | 13 | 14 |
Pledge analysis
Submitted pledges are categorized into three broad pledge thematic areas:
Law and Policy:
Law and policy pledges are the foundation for sustainable inclusion of refugees, other forcibly displaced and stateless people into national health systems, policies, and programmes, and enable equitable access to services at par with host communities. These commitments by refugee-hosting countries create an enabling environment and are frequently accompanied by concrete measures going beyond policy changes. Examples include pledges to provide equitable universal access to health services for all refugees through various means such as policy changes, (e.g., Governments of Brazil, Chile, Armenia, Morocco, Paraguay, Moldova) and inclusion in national health programmes and social health insurance schemes (e.g. Governments of Kenya, Thailand, Mauritania, Nigeria, Cameroon). Other pledges focus on the integration of parallel health services into governmental health service provision to enable effective inclusion (e.g. Governments of Chad, Uganda, Iraq), including as part of approaches to transform camps into settlements (e.g. Government of Ethiopia) as well as specific pledges for the inclusion of refugee healthcare workers into the national health workforce (e.g. Government of Slovakia).
Programmatic support:
Complementary to policy pledges, programmatic pledges enable the effective inclusion of refugees into national health systems and strengthen the national health system through technical, financial and material assistance to effectively deliver health and nutrition services for all refugees and host communities. Donor countries (e.g., Governments of Belgium, Denmark, Germany) and international organisations (e.g., Gavi, Global Fund, IOM, UNFPA, UNICEF, WHO and 27 UN country teams) pledged to enable effective inclusion into national health systems. An additional range of pledges from donor countries (e.g., Governments of Austria, Australia, Canada, Japan, Korea, Slovenia, Sweden, United States), and civil society organisations (e.g., International Medical Corps, Medical Women’s International Association, Society of North American Refugee Healthcare Providers and individual health care providers) aim to strengthen national health services as well as to enable complementary health services in support of refugees and host communities. Private sector partners and foundations (e.g., “la Caixa” Banking Foundation, Qatar foundation, Sony Group Corporation, UN Foundation) pledged more than 55 million USD5. This will play a vital role in advancing sustainable inclusion in health systems and social health protection schemes, alongside providing technical assistance to design and implement results-oriented projects in partnership with key stakeholders. Many pledges are closely linked to other multistakeholder pledges such as Fostering Mental Health and Psychosocial Wellbeing, Economic Inclusion and Social Protection, Climate Resilient Sustainable Human Settlements for Refugees and their Hosting Communities, as well as regional pledges such as Expanded Resilience, Enhanced Solutions for Rohingya Refugees, and are reflective of the multisectoral needs and the focus on comprehensive solutions.
Data and evidence:
More data and evidence are needed to promote effective evidence-based approaches, to support health systems planning and to monitor equitable access to health services. Pledges aim to strengthen national health systems by supporting collection of national data and indicators; supporting evidence generation through research and innovations in service delivery; and promoting international norms and standards and developing evidence-based tools and guidance to inform public health policy and practice (e.g. WHO). Moreover, the Johns Hopkins University led a joint pledge of 10 academic institutions (American University of Beirut, Columbia University, London School of Hygiene and Tropical Medicine, Queen Margaret University, University of Calgary, University of Geneva, University of Palermo, Upstate Medical University, and York University) aiming to extend their academic expertise to the field of refugee health through research, advocacy, and educational initiatives, including scholarships to refugees. Complementary, partners pledge to develop and disseminate global advocacy briefs, and other tools to advance access to inclusive health services (e.g. Women’s Refugee Commission).
Matching
- The Government of Germany commits to match three pledges made by the Governments of Ethiopia, Kenya and Mauritania to enhance refugee inclusion and support to promote access to public services such as health, WASH, education and others through various initiatives including urban settlement improvements, integrated services provision, and national social protection systems.
- The Humanitarian International NGO Network (HINGO) pledges to match the Government of Uganda’s commitment to continue managing and integrating the infrastructure and services, including in health.
- The Government of Denmark together with the LEGO Foundation, Novo Nordisk Foundation and Grundfos Foundation has formed an alliance to respond to the protracted forced displacement situation in Turkana County, Kenya with a focus on strengthening integration of services for host communities and refugees within the programmatic areas of health, education, water and self-reliance. This alliance supports the pledge of the Government of Kenya on transforming camps to settlements and inclusion in national services.
Recap and next steps:
During the GRF, the multistakeholder pledges on National Health System Inclusion and Fostering Mental Health and Psychosocial Support were announced jointly on the first day by Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization and Ms. Louange Koffi, refugee nurse and youth advocate. Additionally, a high-level event “Achieving Health and Wellbeing For All” was held with high-level panellists from governments, refugees, international organisations, civil society and private sector.
Going forward, the Group of Friends of Health for Refugees and Host Communities intends to sustain the positive momentum demonstrated at the GRF and will continue to provide support and technical assistance to advance pledge implementation. The Group will capitalise on global and regional events and multilateral processes to advance inclusion in national health systems and galvanise additional support.
Footnotes
- Until 30 June 2023
- Refugees and host communities
- Global pledges may also refer to those that have yet to determine a country focus or cover multiple regions.
- Contributions are linked to more than one multi-stakeholder pledge
Leadership
- WHO
- Kingdom of Morocco
- Global Fund to Fight AIDS, Tuberculosis and Malaria
- UNICEF
- GAVI
Supported by UNHCR
Contact details
- Sandra Harlass, Senior Public Health Officer, UNHCR, [email protected]
- Claudia Marotta, WHO, [email protected]
- Aiman Zarul, WHO, [email protected]
Calendar
- 22 March 2024 - Group of Friends of Health for Refugees and Host Communities meeting
- May 2024 - World Health Assembly
- October 2024 - Group of Friends Health coordination meeting
- Q1 2025 - Stocktaking event
- May 2025 - World Health Assembly
- Q1-4 2025 - Group of Friends Health quarterly coordination meetings
- December 2025 - High-Level Officials Meeting